Preparing for the California Acupuncture Licensing Exam (CALE)

To my fellow students of Chinese medicine who love the medicine itself, but struggle with standardized testing, this is for you.

A note for non-practitioners about acupuncture licensing exams

In the USA, Chinese medicine is state- regulated. California has the most stringent educational and other licensing requirements. It is the only state that does NOT recognize the National acupuncture licensing exam (NCCAOM). The NCCAOM has four modules: foundations, acupuncture, Western medicine, and herbal medicine. Each module is taken separately, with 100 questions and 2.5-hours each. This makes it easier for students to prepare for the exam, studying one topic at a time.

The California Acupuncture Licensing Exam (CALE) combines the four NCCAOM modules into a grueling 5-hour 200-question exam with more trick questions, complex case studies, and clinically irrelevant trivia than the NCCAOM.

Test Preparation programs

Here are the three main test preparation programs, listed from least to most expensive:

- TCMreview.com (I used this program)

- Linda Morse’s class

- TCMtests.com (I used only during free days)

Using a test preparation program streamlines the intimidating process of reviewing 4 years of accumulated material, 2000 years of history, changing rules/ regulations, and shifting western medicine research.

Choose either TCM-review or Linda Morse’s program for your base program. Search on Youtube for some free sample videos from both to taste their teaching style, and see what resonates. I enjoyed TCM-review’s well-organized content. Bina teaches all of the Chinese medicine classes, methodically covering what to focus on through HB Kim and the course reader. Whenever I had a question, I directly emailed or called her, which was deeply helpful. TCM-review posts free review questions onto Facebook daily.

TCM-tests has helpful test review questions. The first Tuesday of every month is free. So, go test-drive the site to check it out! They post daily review questions onto their site, as well.

I enrolled in TCM-review’s self-guided CALE preparation program during my final quarter of school. I struggled to finish the weekly modules, which included 3 hours of videos, a handful of quizzes, and readings. I went overboard and exhausted myself for the first few months, before I learned to keep it simple:

• Only highlight, write down, or study what Bina emphasizes.
• If something is particularly confusing, either look up more information in a different academic resource or email Bina. She usually responds within a day, with helpful and encouraging explanations/ suggestions.

Time management

My first panic attack hits at 4:30 AM, a month before my first exam, the NCCAOM foundations module. As I stand retching over the bathroom sink in the pre-dawn darkness, I realize I have to change. I was working too hard, and driving myself into an inefficient, anxious frenzy.

I re-prioritized my study strategies and life design:

Mornings

- I journal and sip tea first thing in the morning (usually around 5 AM), prior to studying, or any internet exposure. I light a candle and some incense, invoking support from my ancestors (excellent test takers), and the Earth.

- I then study until 6 or 7 AM, going through whatever is most important, usually taking a quiz, watching a video, or editing flashcards.

- After morning study, I practice yoga asana, eat breakfast, then resume studies by 9 AM.

I enjoy a weekly “study adventure” to local wild places, overflowing my fanny pack with food and study material. I walk, bike, and drive to a rotating collection of mountains, rivers, local parks, and the ocean.

Work

After graduating, I increased my yoga-teaching class load to 7 studios, scheduling classes in the evenings, when I am less productive, but ready for social engagement. Test preparation can be lonely, and mentally, emotionally, and spiritually draining. Teaching yoga provided an incredible balance: I share what I love, engage with people who I care about, and integrate information on all levels.

Are you more focused and productive in the mornings or evenings? Pattern your day according to your natural rhythms. I honor my "morning person" temperament by only scheduling appointments after lunch.

I cancelled all teaching engagements three weeks before my exam. Walking in the hills going through flashcards, I notice rising anxiety and overwhelm, and realize, “I do NOT want to teach tonight’s class.” I was so focused that any disturbances would cause more stress.

Notice how you are feeling. Make life changes as necessary to support your study success!

Evenings

I prefer studying outdoors during the day, and doing computer-oriented work in the evening, such as taking quizzes, editing flashcards, or watching videos. I try to climb into bed by 10 PM. Most nights, I feel a sense of guilty incompleteness: I didn’t study enough today. I felt a constant sense of not enough. This feeling is miserable and useless, but difficult to combat. I tried to push it back by covering flashcards until I fell asleep, but this would usually give me anxiety-dreams, or nightmares.

Set a time to stop studying. Give yourself a break. It’s difficult to stop, when you’re a perfectionist workaholic (as I am). But, it’s absolutely necessary, to prevent burnout, panic attacks, or worse. Resting peacefully each evening allows information integration, building long-lasting brain-trails.

Flashcards

Bina recommends making flashcards for everything covered in the course (besides what you know very well already) and having a daily strategy of studying all flashcards nightly, setting aside cards you’re getting wrong, then reviewing the “wrong” flashcards first thing the next morning.

I couldn't use Bina's technique. I made a total of 8350 flashcards through my six months of study, assiduously inputting each week’s information into Quizlet. I was overwhelmed by my massive collection, and inefficient in reviewing them. I quickly fall asleep if I sit around and study. I need constant movement and diverse natural environments.

The still sacred silence of the hills/ mountains helps me focus; I quickly move through large amounts of study material. I walk with flashcards until I find a beautiful place to study, am hungry, or am so mentally exhausted that I must rest. I then sit in the shade, flip through books or charts, or cover larger flashcards that are too complicated to read while walking.

Paper flashcards get bulky and fly away when it’s windy. I prefer online/ digital flashcards. Quizlet supported me through graduate school, and continued to help me pass my board exams. I enjoy adding photos onto complex cards, keeping cards organized in folders, seeing other students' cards, and Quizlet's ability to read me my cards. I walk, listening to my cards, starring and unstarring, gazing down every once in a while for clarification.

I organize material into specific folders, numbered according to priority. I “star” my "wrong" flashcards, studying the starred cards the next day. I keep track of everything by charting when I cover a flashcard set, how many are starred, and how many total in the set. As my test date drew closer, I noted "mastered" categories with a blue circle.

I created larger flashcard categories for sitting and reading/ studying. I created smaller flashcards for walking. I noted which flashcards were for walking (走), or sitting (坐).

Keep topics small, to move through quickly, and Quizlet-readable while walking. Color-code. Write things down over and over. Make studying fun, colorful, and physical.

It’s a Marathon

I prepared for the CALE for 6 months. During school, I studied as much as possible between school, work, and 450 miles of travel each week. After graduation, I studied every single day, all day on most days. I scheduled in at least one hour-long physical activity daily, besides teaching and practicing yoga. Your study strategy depends on you.

What type of learner are you? I’m a kinesthetic learner and artist. I enjoy the physicality of programming flashcards into the computer, making them fun and beautiful, and then walking with them through miles of wilderness. Bina suggested a rigorous study schedule: scheduling topics each morning, then studying in 2 hour blocks. I tried to follow the regimen off and on for a few months, and found it anxiety-provoking. I am much happier and more efficient if I get up when I need to, otherwise I procrastinate. When I get slightly restless, I set the timer for 5-10 minutes, then take a snack, garden, or creativity break until time's up. When very restless, I shut everything down, and go for a flashcard walk up the hill or down to the ocean. You are in control of your study-journey.

When you’re bored, exhausted, or procrastinating, go take a break. Stay efficient. Don’t get bogged down in details. Clarify what you don’t understand, then move on. 

Rest

Schedule in time for rest and play. Spend time outdoors. Get exercise. Spend time with friends.

These things are simple to say, but must be scheduled in during test preparation. Otherwise, focused zeal can take over, frazzling the nervous system.

Have fun with your studies. How can this process be joyful? This is a precious moment. You are here now, and will not be here again, as a soon-graduating or freshly-graduated acupuncturist, preparing for licensure. This is purgatory. Welcome here now. Look around. Enjoy it, while you’re here. Have fun.

Test Preparation Tips

I focused on my weak spots during TCM-tests free days, the first Tuesday of each month. I took all most of their mock exams for each NCCAOM category prior to those exams, also during free days. I scheduled weekly mock exams the final month leading to the CALE (part of the TCM-review program). Utilize both free and paid resources!

I memorized the entire “Big Picture” page from HB Kim, and all 83 formulas and categories. I scribbled both down within 20 minutes every week. If I started dropping information or going slower, then I would increase the frequency to twice a week, every other day, or daily. 

Prior to my actual exam, I scribbled down most of the Big Picture, then added other acupuncture or herbal lists as necessary. They only allowed me one piece of scratch paper, so I kept my reference tables concise. I repeatedly wrote and erased notes throughout the test in the remaining space.

I developed these test-taking strategies during my 4 mock exams. I tested in a quiet focused environment, similar to the actual testing environment. I gave myself a 10-minute bathroom/ snack break every 50 questions, which I aimed to finish in an hour. I’d studied enough that I trusted my intuition more than my logical mind: if my first thought is A, then go with it. Don’t doubt, and certainly don’t overthink. Keep it simple. Keep moving.

Western medicine

I felt prepared to take my exam with my review course, except for western medicine. Western medicine is a vast topic. The professor who covered that section of the TCM-review course frequently went off-topic, veering into personal/ clinical stories that are interesting, but unnecessary for test preparation. I sped through those videos at 2.5x speed. 

I spent three days sitting by the ocean, reading through the entire biomedicine section of HB Kim. I made tables for what I found confusing or intriguing, and drilled flashcards and quizzes. 

Scheduling exams

Most California students take both the NCCAOM and CALE, for a total of five exams. After doing much research, I too chose this route, although it is more expensive, stressful, and time-consuming. It is better to take these exams while the information is still fresh from school. Once clinical practice begins, the didactic academic information falls away, while sitting-still-and-studying ability also declines.

Either complete or start taking the NCCAOM while still in school. Most of my peers from my past schools (in FL and OR) completed the NCCAOM while finishing their final year of school. I incorrectly thought that that rule was different in California, but it is not: pass it while it’s hot. Get it done.

My testing schedule

Bina was instrumental in my study strategy. I came to deeply trust her judgment. She suggested taking the NCCAOM foundations and acupuncture modules first, CALE, and then biomedicine and herbs. Because of time constraints, my testing schedule ended up as:

1. NCCAOM foundations module

2. CALE

3. NCCAOM acupuncture module

4. NCCAOM biomedicine module

5. NCCAOM herbs module

After graduation, I focused my energy and passed the NCCAOM foundations module. You can read about that journey here. Preparing for the foundations module solidified that information in me. I felt confident and indestructable here, only revisiting these flashcards intermittently until my big CALE exam, rifling through one final time right before CALE.  

I took the NCCAOM acupuncture module one week after the CALE. It has slightly different content than the CALE, which required an about-face in these categories:

- needle depth

- point location

- crossing points

I read through HB Kim for these sections, and scoured Quizlet for others’ resources. I only drilled these categories, trusting that my CALE-prep was sufficient to also carry me through the NCCAOM for other categories, especially within such a short span of time between these two exams.

Success.

The test

Visit my "Ode to Tests" post for some before, during, and after test strategies and suggestions. 

The end

“Geoff,” I texted my mentor, two weeks before my scheduled CALE exam, “Can we talk?” We spoke on the phone a few hours later. I had completed my 6-month TCM-review course. My CALE exam was scheduled in 2 weeks. I still didn’t feel ready. I was confident in some areas, but weak in other areas. I knew my weak spots, and feared them. Am I good enough? Am I ready enough? Take it now, or push the test back? Geoff counseled me, “Give it all you’ve got. You’ve studied. You’re prepared. You’re at peak performance state. Get it.” He said, “Go in with the intention to kill the beast. Even if you don’t kill it, you hurt it bad. It walks away limping.” This fiery bold image, coupled with my usual more-peaceful ancestral-prayers, and months of dedication and struggle, carried me through to test day.

“祖先們! (Zu xian men),” I call out to the sunrise ocean, “Ancestors!” I’ve already walked through a few hundred flashcards in the dawn chill, barefoot through the cold sand. I feel tired and overwhelmed, and am asking for support from my ancestors, the same questions I would later ask Geoff: Am I ready? Is it time?

Six dolphins simultaneously swim by, blow-holing parallel sprays of water high above waves, alighting my heart with hope and possibility. Here we are.

The beginning (What now?)

I’m building my practice. It’s difficult to rest after months of intense dedication. The fire that lit my test-preparation path now guides my business-building trail. This is a life-long journey of adventurous study, with its challenges and triumphs. I am grateful. 

Have fun!

Board exam 1

The test was difficult. It was mostly what I'd prepared for, except different diagnostics thrown all together for answer possibilities, and more "treatment plan" type questions than straight "diagnosis" questions.

I cancelled all work and social engagements the week before the test, cycling through old quiz questions on TCMreview.com and reviewing flashcards, honing in on weak spots. Two days before the exam, I took two full-length mock exams on TCMtests.com. The day before the exam, I took a self-constructed mock-exam at the same time as I'd perform the next day, relaxed (surf, hike, do a few more flashcards to ease my mind), ate a delicious nutritious macrobiotic supper, took a walk, took a bath, slept, then woke at 5:30 AM to perform--- and succeed.

I take a break at the half-way mark (50 questions down, 1 hour in) to pee, take some power-poses in the bathroom mirror, and devour a chocolate bar. The two hours fly by. Every time I start sweating or feeling anxious, I stop, take "chin" mudra (connecting my thumb and forefinger), breathe deeply, then proceed. The computer doesn't allow me to cross out answers or highlight important points, so I fill my scratch- paper with small bullets, key points, and doodles. I draw symptoms for complex cases onto a doughy-sticky-figure human body. I draw out complex tongue and pulse diagnoses. I knock off wrong answers on my bullet-points.

My feelings at the end of the test, as I put a hand on my heart, still my breath, then click "next" to complete the exam--- are complex. The screen flashes "pass" and I hold back tears in the quietly clicking testing room. I am beyond words, and still am.

This is the first of five tests, and an auspicious beginning. I am grateful to everyone who made this focus possible, and my studying-process joyful, meaningful:

Ben, for your playfulness, delicious meals, and adventure partnership. My yoga community, who keeps me responsible, sane, and life filled with purposeful sacred embodied play. Cynthia, for reminding me that this testing process is an opportunity for presence, and to enjoy it while I'm here, while honoring Body Wisdom. The Ocean, for cleansing my body, heart, mind, and sinuses. The mountains for grounding and magic. David, Geoff, and Justin for sharing  parallel TCM experiences, and continual inspiration and inquiry. Geoff, for reminding me to "keep swimming." My grandpa from six generations ago, who wrote our family poem that inspires this journey, informs my name and spirit, and infuses my life with love, meaning, excellence, and dedication to lineage. To all my family and friends, and seen and unseen forces. To all my relations. 

Taking the test itself feels like a very solo adventure, like traveling to a new country where I've never been, and know no one, with a mission to "get the treasure--- and bring it home." I've prepared intensely for the mission, but upon landing, it's still a whole new planet. I'm grateful for my large community of support at home. It's nice to be able to leave--- and come back. Next time, the testing process will hopefully be easier, more familiar. Continued dedication (with strategic restful play) until then.

Next tests: September, October, February, May. Thanks for joining my journey.

Big Love.
Deep bow.

(from a journal entry after the NCCAOM Foundations exam, written in the Sespe Wilderness. I went for a short 24-hour backpacking journey the day that I completed the exam.) 

Ode to Tests

I wrote this post almost immediately after my graduation exam. I didn’t know test results yet, but was so adrenaline high from the test, and exhausted after months of preparation, that I had to write something about the process. If you are preparing for a big exam, then I hope that this is helpful for you. (And yes, big relief, I passed.)

Ode to Tests

Clinic entrance exam. Clinic exit exam. Graduation exam. And now, coming up, the California board exam. Then, four national exams (NCCAOM). One exam after another, the never-ending march of terror and exhaustion. I greet you with flashcards and chocolate. For you, dear reader, perchance a fellow student, perchance a curious onlooker, I share these test-tackling strategies that have carried me through, and will hopefully continue to carry me through, to graduation, and subsequent licensure. One small win at a time.

Before the Test

Prepare

Flashcards. Review daily. Go onto www.quizlet.com and make an account. Plug in small digestible snippets of all collected and pertinent information. Organize into categories. Study by category. Do flashcards everywhere. I studied flashcards while hiking backcountry, flying across the country, soaking in steaming baths. I flipped through 100 flashcards pre-dawn before leaving the bed, 100 more before falling asleep, and in every possible open moment: standing in grocery lines, waiting for gas, and even while stuck in hellish Los Angeles traffic. Practice tests. Practice tables. Get familiar with the material from every direction. Talk about it with everyone. Look up what you don’t know. Make it fun, visual, creative. Color-code. Bring it to life. Spaced repetition, dedication. Set a study plan, and follow through.

The Day Before

No cramming. Your last day of studying is 2 days before test day. After weeks to months of accumulated effort, allow yourself to rest the day before the test. Eat well: healthy whole foods that will energize you all through the next day. Go for a hike. Do what gives you joy. Flip through a few more notes to ease your mind, but remain calm. Before bed, have everything prepared for your test day: clothing, food... everything. Visualize your plans for the whole test. Picture success. Feel it. Sleep early.

Day Of

Stretch in the morning. Eat well. Maintain a relaxed focus. Enter the zone. Get there early. Game on.

During the Test

Food and Drink (this worked at school, but board exams will only allow water)

If the test allows it, then bring ample fuel: relaxing tea for nervousness (Kava, Rose, Passionflower), stimulating tea for the easily bored (Green tea). I had tea bags of both. Coffee or wine for the decadent (I like chocolate covered coffee beans). Chocolate for joy, comfort, and energy. Oranges for an energizing wake-up call. Roasted sweet potatoes for satisfying long-lasting energy. A protein bar to quickly satiate true hunger. Cookies for true decadence. A dropperful of a relaxing or stimulating tincture (relaxing for me) beforehand, to get things started on the right foot. An extra secret squirt into the tea, for extra good luck.

The Test

Start with what you know: I scribble out a few reference tables before starting the test itself. They smile at me with my test and food, helpful for when I get overwhelmed, reminding me of the basics. Flip to the section of the test that is easiest, and finish it. Build confidence. Return to a hard section. Alternate back and forth: build confidence, tackle something challenging. Note the time. Move quickly. Let go, if something is too difficult. Mark the page to return later. Trust intuition: first thought is often correct. Bubble it into the answer sheet. Mark what I’m unsure about, to double check after completing the entire test. Only double check those answers. Onwards.

Movement

Get up to to “pee” at least once an hour. Give your brain a break. Pace around in the bathroom or hallway for a little bit. Get some blood flowing into the body and brain. Take a breather. Swing your arms around. Then return to the testing room.

Maintain focus, but rest as needed. Close your eyes. Take slow deep belly-to-chest breaths in and out of the nose. Remind yourself, “It’s okay,” with palms facing up under the table, or pointer finger and thumb meeting in “anjali mudra.” More relaxation for more success. Then, back to it.

After the Test

First, rest. It’s been a journey. Celebrate both wins and losses. Review the test. Learn from mistakes. If there’s more tests on the horizon, then make more flashcards from fresh test material. Re-strategize as necessary. Onwards. 

~

Other Resources
Here's a podcast on high-level performance under stress, from Scott Weingart.

(image from Scott Weingart)

Choosing a Chinese Medicine School

Chinese medicine, and any true course of study, is a lifetime of study. Even if you don’t pursue formal Chinese medicine for future licensure and practice, you can still study it for pleasure, historical value, and quality of life improvement. This article is for those who hope to formally embark on this Chinese medicine journey, who inquire about my experiences at the three Chinese medicine schools I attended, the seven I visited, and the numerous others that I researched before committing to this education. 

Graduate level Chinese medicine education, usually to earn a Master’s degree, is required for licensure to practice acupuncture in most places in the USA. A few states provide licensure without a degree, fewer don't even require licensure. See the NCCAOM website (our licensing board) for the laws for your state. Here, I write about picking a suitable graduate level Chinese medicine program in the USA for licensure, as my experience has been thus. 

It is a bittersweet investment, and exhausting, challenging, rewarding, and life-changing journey. It is only the formal beginning of this journey. I hope that this article is useful and helpful. Enjoy.

Note: I started writing this article when I left NUNM last spring. Over a year later, it is still unfinished. I’m still in school, and keep adding to it, but I want to share it now, as we're approaching application time for fall 2018 matriculation in most schools. Perhaps I’ll publish a more polished version in the future, but here it is, for now. Pardon the unpolished bits. 

Key to a few terms, before we begin
AFEA= Academy for Five Element Acupuncture (my 1rst school, in Florida)
NUNM= National University of Natural Medicine (my 2^nd school, in Oregon)
AMU= Alhambra Medical University (my 3^rd and current school, in CA
ACAOM=Accreditation Commission for Acupuncture and Oriental Medicine (they approve schools)

NCCAOM=National Certification Commission for Acupuncture and Oriental Medicine (they create the national board exam)

You

What do you want?

Get clear about your goals, needs, desires, strengths, and weaknesses. What are you willing or not willing to give up or compromise for this education? This includes home/ location, current job/ career, financial commitment, etc. If you want the best education and are able to commit time, money, home, and likely even career, then move to China or Taiwan, and commit to learning Chinese first, then studying for another 6-7 years, there. However, USA acupuncture licensure requires that you study in the USA. Students who study abroad have to take a certain number of classes here in the USA, and then take the USA acupuncture board exams for licensure. I decided not to study abroad for that reason, and also for reasons of time and comfort. I can always return to China/ Taiwan after I graduate and into my future for supplemental studies.

Every school has its strong and weak points. Decide what’s most important to you. If herbs are your priority, then choose a school with a strong herbal program. If saving money is your priority, then choose the cheapest school. If you want to focus on a certain style of acupuncture, modality, demographic, or condition, then pick a school that excels in that area. Otherwise, pick a school that provides a solid foundation of the basics (diagnostics, points, and herbs), with a strong clinical program, and at a reasonable price. Be idealistic, yet realistic. No school is perfect.

What kind of learner are you?

Do you prefer small classes, or large lecture halls? Are you more of an introvert or extrovert?

What are your goals?

If you’d like to be a clinician, then choose a school with a strong clinical component: many hours observing practitioners with over 10 years of experience. Some people are fantastic clinicians, but terrible teachers. See what you can learn best with, and what you can simply “put up” with. If you’d like to be an academic, then attend a didactic school with excellent philosophical lecturers, and perhaps go for a doctoral program in classical Chinese, like what I started off doing at NUNM. If you are attending school for self enrichment, and don’t want to pursue it as a career, then simply pick a school with a style and cost that you resonate with, like some students do at AMU.

Location

Where do you live, now? Where do you want to live, in the future?

Pick a school where you’ll happily live for 3-5 years, and likely after graduation. Students form life-long relationships with fellow students, professors, patients, and local community. After graduation, most students remain local to school. Choose a place where you could live long-term, where the cost of living, landscape, weather, human population, and work availability all suit you. Research the acupuncture laws in your desired state(s) of practice. Do those state(s) have their own board exams or requirements? Will you live/ work in a state that requires both herbal and acupuncture board exams for licensure? Does your school cover herbs, if it’s required by your state laws? Is your school accredited by ACAOM and your desired state(s)?

Money

“Pick the cheapest school where you can get out the fastest,” said one of my mentors as I was researching schools, “You learn everything after you graduate, anyhow.” “Don’t worry about the money,” said another, younger friend, “it’s an investment.” I picked my first school, AFEA, because it fit my nomadic lifestyle, focused on a style of acupuncture that I liked, and was reasonably priced. However, I found focusing on just one style of acupuncture to be limited in perspective, and decided to change to the most expensive school in the country (NUNM), to better fit my academic goals. After 1.5 years there though, I felt like the cost of my education was not commensurate with the quality of my education, and decided to leave again, this time to one of the cheapest schools in the country (AMU), to just put my nose to the grindstone and finish my education as elegantly and cheaply as possible.

How much are you willing or able to pay? Do you have a family to support, or pre-existing debt? There are almost no scholarships available. Most students go into heavy debt of over $100,000 including all expenses, depending on the school, and location. Some schools offer negligible in-school scholarships. Government-funded financial aid is available at most larger schools, but at cut-throat rates that begin accruing immediately upon withdrawal of funds. At NUNM, our government loan rate was around 6%. Some schools offer low-paying work-study. I juggled a few work-study jobs at NUNM, which included filling herbal prescriptions in the school medicinary, assisting at school events, and caretaking plants in the school garden. These were relaxing jobs that paid minimally, but were wonderful learning opportunities. AMU and AFEA are both too small to offer work-study, but allow flexibility and a lower price tag, so students can still work part-time and emerge with less debt.

Does tuition cost remain consistent through school, or does it increase yearly? At NUNM, our tuition increased every year. When I left, it was $420 per credit, with costs rising as much as 4% each year. Most students left NUNM with $150,000 to $200,000 (and up) in debt, depending on what program(s) they did. A friend who is a father and primary provider of his household started off getting enough financial assistance for NUNM but once the tuition increased, was no longer able to make ends meet. Most NUNM students are enrolled full time, taking out full loans. Few hold part-time jobs, as NUNM has a demanding program that requires full focus and time commitment. AMU is a quarter of the cost, at $125 per unit. Most classes occur in evenings or on weekends, so students can work full or part time while attending school, accruing less or no debt.

What are you willing to sacrifice, or invest in, for this education? Total cost of education includes cost of living (ie. food, rent, clothes), associated student costs (ie. expensive textbooks, clinical gear), and other unforeseen expenses. After graduation, expenses include board exams, starting a business, etc. We are not guaranteed jobs upon graduation, but need to be creative entrepreneurs. It can take 2-3 years to build a practice, depending on your location, business skills, practitioner skills, and luck. Research your local Chinese medicine market, and talk with seasoned practitioners. This is a big investment.

Time

Do you want to work part time, and graduate in 5 or more years? Or do you want to fully commit to school, and graduate in 3-4 years?

Business

Business skills are an integral part of “making it” as an acupuncturist. Most schools have a weak business program, if it exists at all. Invest in business classes as you get close to graduation, pick up books at the library on this topic, notice how things are run in the school clinic, and ask fellow acupuncturists in your desired practice location. School will not provide all the tools that you need to begin a practice. We must develop strong business skills and become creative entrepreneurs on our own.

Style

What’s your personal experience with Chinese medicine? What brings you to this medicine? What style of acupuncture do you enjoy, or has been effective for you, as a patient? Are herbs effective for you, or not?

Schools usually offer electives that expose students to a variety of Chinese medicines styles or techniques. Other schools offer specializations, such as in sports medicine, geriatrics, or gynecology. Five element acupuncture and Eight extraordinary channels studies usually lend themselves well to more psychologically focused work. Craniosacral, lymph massage, shiatsu, or other forms of bodywork are helpful for those who enjoy physical contact with patients. Shen-Hammer pulse system and Applied Channel Theory provide more detailed diagnostic tools. Most of these skills can be studied after school, for CEU’s. At NUNM, many professors offered workshops outside of school. My anatomy professor taught various bodywork classes outside of school. My foundations teacher taught sound healing in Chinese medicine. Being an ancient form of art and medicine, each professor and clinician has their own relationship with and approach to the medicine. Don’t be discouraged if a school doesn’t offer an elective you’re interested in. Take CEU’s after graduation, and make your business pay for it, through tax write-offs!

Half of our educational content includes western medicine, although it’s far less emphasized, with mostly take-home exams, and professors of fluctuating skill levels and often no understanding of Chinese medicine. Take these classes online, if possible. Nonetheless, Western medicine allows us to communicate with other healthcare professionals and patients in a shared language, and offers alternate perspectives to support or refute diagnostics or treatment principles. The more tools the better, though sometimes it can get messy.

There is always more to learn. With a plethora of options, don’t get bogged down in options, or water down your education. Pass your board exams. Enjoy the journey, too. Be well informed, yet focused. “Your best teachers are your patients,” said Dr Wang Ju-Yi.

Master’s vs “First Professional Doctorate” degree

Chinese medicine practitioner scopes of practice varies by location. In the USA, each state has its own rules. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) administers the national board exam, which includes four parts: Foundations of Oriental Medicine, Biomedicine, Acupuncture, and Chinese Herbology. The first three portions are required for most states, while the Herbs portion varies by state. Some states require both Herbs and Acupuncture certification to become a licensed acupuncturist (LAc), while other states only require Acupuncture certification to practice. A few states include other tests. California has its own State Boards, instead of the National Boards (this will change next year). New Mexico has an additional practical exam, to take after passing the National Boards. After passing both tests in New Mexico, Chinese medicine practitioners are given the title of “Doctor of Oriental Medicine” (DOM), and are primary care physicians (PCP). In California, acupuncturists are also PCP’s. In most states, we are just “Licensed Acupuncturists” (Lac), sans PCP rights/ privileges/ responsibilities

In first professional doctorate programs, students concurrently take the doctoral program with the Master’s program. Our field is rapidly changing, moving more towards a doctorate being required, instead of optional. Some older practitioners think that directly going for the first professional doctorate makes more sense, to save time and money. Others suggest finishing up the Master’s, starting a practice, and getting more experience and focus first, before embarking on the next stage of education. I started off doing a dual degree, found it to be too much work and in a program that was more academic than clinical (I am more interested in clinic than academics), so changed back to completing my Master’s, first.

Post doctorate (Ph.D) programs also exist in Chinese medicine, though students usually pursue this after a few years of practice. This course of study can be engaged in either the USA or abroad.

When Visiting Schools

• Speak with as many different students as you can. Get diverse views on the school. A few important questions:
  • What are your favorite and least favorite classes and professors?
    • Sit in on both the “best” and “worst” classes, to know the best and worst of what this school offers. Talk with professors after class.
  • Who are the primary professors for core classes, such as foundations, points, diagnostics, herbs, and formulas?
    • Sit in on their classes!
  • What do you most like and dislike about the school, in general?
  • What are the strong and weak points of this school?
  • Notice what each individual has to say, and pay particular attention to patterns across differing individuals.
  • Ask the Dean this question, too.
  • Do professors and administration respond to student requests? How? How quickly? What's the procedure for voicing grievances, and conducting school-wide changes? Get solid examples of this. 
• Be bold, and ask professors the above questions. Many professors teach at different schools, and can offer perspectives from the different schools that they currently teach at, have taught in the past, or their own journey as a student.
• Do not just speak with administration. Admin is necessary for processing paperwork, money, and other logistics, but don’t affect or understand course content, and can sometimes be rude or disorganized. (I had bad experiences at most schools that I visited and attended). Don’t let a bad experience with an administrator ruin your feeling about a school. Ask to speak with the Dean of the Chinese medicine program and again, speak with professors, clinicians, and students.
• Remember that each person you speak with has their own opinions, biases, and personal experiences. What resonates for another might not resonate for you. But if you piece together enough of others’ experiences, it helps create an outline for you to fill in the blanks with your own experiences, perspective, and judgment.
• Notice who the other students are
  • How old are they? What socioeconomic class? Academic/ career goals? Background?
  • Do you feel comfortable with the general student population? Could you be happy with this group of people for 3-5 years?
• Who are your professors? What’s the ratio of men to women professors? Are there Chinese professors? Do your professors speak or read Chinese? Do they cite the classics, and their clinical experience?
• Sit in on classes with topics that you care most about.
• Get a complimentary treatment in the clinic.
• Ask students and clinical supervisors about clinical progression. Notice the cleanliness and professionalism of the clinic, and how supervisors interact with students.
• Do students seem happy, confident, relaxed, professional, and knowledgeable?
• Once you begin formally engaging with a school, keep well-organized records of everything, ideally digitally, especially payments and agreements. If they lose your paperwork (it's happened to me a few times), then you have it. 

The Curriculum

• Make sure that topics that most interest you are emphasized in the program if possible, or at least included.
• Remember that this is only the beginning of your education. No school can offer everything. Your schedule, including school, possible work, and a life outside of school to integrate and rest, will be packed.
  • I found more richness in my life outside of school than my life in school, such as educational opportunities, people that I want to study with, etc.
  • Even if you don’t resonate with your professors, you can find mentors, inspiration, and continuing education opportunities outside of school. Ask around in local clinics and in your communities, either in person or online.
• You can take such classes as qigong and other electives outside of school or for CEU’s after graduation, usually for cheaper than in school.
  • At NUNM, a 1.5 unit qigong class and weekend-long qigong retreat are part of every quarter. This looks great on the curriculum, and sounds romantic and lovely, but adds up to around $1000 every three months. Most schools only require two qigong/ taiji classes. Then, there’s also personal connection: I don’t enjoy this particular qigong form, and don’t want to spend $1000 every three months on it.

Clinic

Who are your supervisors in clinic? How many years of clinical practice do they have? Do you resonate with their teaching style? How large are clinic groups? What’s clinical progression like? How soon do you enter clinic, upon matriculation at that school? What population does the clinic serve? Does it serve a diversity of people with differing conditions, ages, income levels, etc? What kind of patient population or conditions do you hope to work with in the future, and does your school clinic reflect that?

At AMU, students observe other students practicing. We usually have two teams of students working at once, with a presiding supervisor over the entire shift. First level students observe second or third year students needling. Our supervisor only enters to double check tongue, pulse, and other diagnostics, and help form a treatment plan. Then, treatment is conducted entirely on our own. Second level students needle together. Third level students can needle solo. Most schools have this system. My current opinions, based off of my first quarter in AMU’s clinic:

Pro’s of watching fellow students

- I am sometimes more comfortable asking my peers simple repetitive questions (“stupid” questions) than high-level practitioners

- We have to take initiative and develop prowess in our work, as no one holds our hand

Con’s of watching fellow students

- Lack of experience

- It can sometimes get chaotic or messy

At NUNM and SIEAM, students start by observing clinicians with 10+ years of experience. As they progress in clinic, they have a closer relationship with their supervisors. Watching someone practice who has years of experience is very different than watching fellow students: it looks like a graceful dance, rather than a technical act. I find it inspiring and beautiful, and sometimes daunting, in a “this is a lifetime of learning” way. It’s rare to find a school where you can observe seasoned clinicians. Opportunities exist outside of school to observe excellent practitioners though, either via serendipity, self-created opportunities, or established programs with seasoned practitioners (usually more expensive).

Self-study

School can only teach you so much. It is only the beginning. The rest is up to you.

Some Schools

California has a plethora of Chinese medicine schools, particularly in the Bay area and Los Angeles, due to the abundance of Asians, here. I now attend Alhambra Medical University (AMU) in Los Angeles, which is one of the cheapest schools in the country, as it’s run and attended predominantly by immigrants, who will not pay the exorbitant fees that westerners are more willing to pay. This is reflected in the education itself, which is just straightforward and practical: traditional Chinese medicine (TCM) with no esoteric decorative flowers, and certainly no exoticism. TCM tends towards biomedical allopathic perspectives, which is the direction that Chinese medicine education in China and Taiwan focus on, more and more. This can be reductionist yet well organized. A deeper investigation of the classics and other styles or traditions can be engaged in during or after school, or upon graduation.

Los Angeles

Alhambra Medical University

My school. A small, cheap, immigrant-run TCM school that teaches to the Boards, with classes in English or Chinese (you choose). A DAOM program was just added, for people who have graduated, already. I am glad to be here, and am happy to share my experiences, if you have questions.

Other small, cheap, immigrant-run TCM schools that teaches to the Boards:

South Baylo University

Dongguk University (has English or Korean language classes)

Larger TCM schools here at a slightly higher cost, with more westerners than Asians:

Emperor’s College of Traditional Oriental Medicine

Located in a strip mall in west Los Angeles

Yo San University of Traditional Chinese Medicine

Qigong is a required class through the entire course of study. They call themselves as a “family style” school, but the founders of the school rarely teach.

Southern California University of Health Sciences

Has a first professional doctorate program, and no Master’s program. A small cohort-based TCM program in a much larger chiropractic school on a large beautiful campus in Whittier.

Bay Area (CA)

American College of Traditional Chinese medicine (San Francisco) 

Well organized. I got a good feeling visiting this school, but did not like the location in super urban San Francisco. Recently partnered with California Institute of Integral Studies (CIIS), which has a transpersonal psychology, somatic psychology, and other interesting programs. 

Academy of Chinese Culture and Health Sciences (Oakland)

Small select staff and students. Warm environment. Seems like an excellent hands-on program. I was not a fan of Oakland (high crime, crowded).

Acupuncture and Integrative Medicine College (Berkeley)

Five Branches University (Santa Cruz, San Jose)

A gorgeous campus and location, right next to the ocean in progressive Santa Cruz with redwoods and fun community. Has English or Chinese classes.

Colorado

Southwest Acupuncture College (Boulder)

Boulder was one of my favorite places to live, at the base of the beautiful Rockies, and in a progressive community with many Universities in a small town, including Tibetan Buddhism Naropa University. SWAC has a campus in Boulder, CO and in Santa Fe, NM. It has an affordable education, with excellent professors in a standard TCM education, with options for specializations in other areas, such as Japanese acupuncture.

Institute of Taoist Education and Acupuncture (Louisville- a Five Elements school run by Worsley’s wife)

Colorado School of Traditional Chinese Medicine (Denver- seems like a standard TCM school)

Portland, Oregon

National University of Natural Medicine (NUNM)

Oregon College of Oriental Medicine (OCOM)

People’s Organization of Community Acupuncture(POCA)

The cheapest option for studying Chinese medicine, but controversial, and only acupuncture, no herbs. No Master’s degree, just licensure. Some dogmatism around community acupuncture, but otherwise great principles. 

Seattle, Washington

Seattle Institute of East Asian Medicine (SIEAM)

Bastyr University

New England

University of Bridgeport(Bridgeport, CT)

New England School of Acupuncture (Boston, MA)

“Classical Chinese medicine” schools (instead of “TCM”)

“TCM,” or “traditional Chinese medicine,” is a post Communist revolution modernized version of Chinese medicine, as synthesized by doctors under Mao Ze Dong. “Classical Chinese medicine” (CCM) refers to pre-Communist Chinese medicine.

Seattle Institute of East Asian Medicine (SIEAM)

I’ve heard great things about this school, and met some wonderful practitioners that graduated from here. It’s a rigorous education, with a lot of information folded into three years, a small cohort, the best professors, and reasonable tuition. If you’re willing to completely dedicate your life for three years to one of the best yet toughest schools, then come here. SIEAM doesn’t allow for transfers, and Seattle is cold and rainy, which is why I didn’t come here. The only school in the USA that teaches students to read and write modern and classical Chinese as part of its curriculum. You start observing in clinic immediately, then learn tuina to start practicing in clinic, before needling.

National University of Natural Medicine (NUNM)

An emphasis on classical texts, with an idealistic yet thoughtful curriculum. Professors often ramble off in inspired yet disorganized ways, leaving students excited yet confused. The most expensive school in the country which is, in my opinion, not worth the cost. Clinic with experienced clinicians who each have their own style. A plethora of diverse Chinese medicine styles and techniques presented. Juicy, but can lead to lack of depth. Qigong and retreats every quarter which increases cost of education.

Daoist Traditions College of Chinese Medical Arts (Asheville, NC)  

Founded by Jeffrey Yuen. More on that, another time.

Five Elements schools:

These schools are focused on “Five Element Acupuncture,” a style of acupuncture compiled by JR Worsley from a variety of approaches to Chinese medicine he learned in his East Asian travels. Students focus on this style of acupuncture, and are not exposed to much else. Pro’s with this kind of focus include graduating with an ability to perform one thing very well. Con’s include not knowing other modalities… but those can always be learned, later. Herbal medicine is not an inherent part of the Five Element approach, but a very basic herbal overview can be added onto the curriculum for an additional cost. Neither school is recognized by California or New Mexico (perhaps other states as well). Five Element style is not emphasized in the Board exams, so students have to prepare for the Boards on their own. Both schools offer a module-based program, which allows students to hold part-time jobs outside of school for the first two years of their education, before a full year of clinical residency in the final year.

- Academy for Five Element Acupuncture (Gainesville, FL)

- Institute of Taoist Education and Acupuncture (Louisville, CO)

Supplemental online education

- Andrew Nugent- Head (Association for Traditional Studies)

- Arnaud Versluys (Institute of Classics in East Asian Medicine)

Studying in Taiwan/ China

- Applied Channel Theory

- Studying in Taizhong, Taiwan at the 中國醫藥大學

Another perspective on this topic from Andrew Nugent-Head, a professor and practitioner that I greatly respect and admire:

http://www.traditionalstudies.org/where-should-i-go-to-chinese-medicine-school-which-is-the-best-school/

Related Blog Posts

- My first (and only) AFEA intensive: daily journal entries (08/2015)

- NUNM year 1: a review (09/2016)

​~

Other Ideas

A quick idea- sketch of future potential additions to this article, as it’s not finished, and will likely never be, as the field continues changing rapidly, and I do, too.

• school size
  • NUNM (big)/ SCUHS
    • + counselers, and other perks money can buy
    • + networking (ie events on campus)
    • - bureaucracy/ complicated chain of command. Difficult to elicit change, or be heard
    • - same professors
    • + workstudy opportunities
    • + students of other modalities (ie ND/ undergrad/ etc @ NUNM, chiro @SCUHS)
    • + opportunity for dual majors, or studying other things
    • - usually more expensive (at NUNM, our tuition paid for new buildings to grow school)
    • + more options, such as scholarships
  • small (AFEA, AMU)
    • AFEA= cohort 
    • + know everyone. May be easier to elicit change, or get needs met 
    • - if you don't get along, you're stuck with them 
    • - less opportunities or networking
    • + more homey 
• physical accommodation considerations
  • elevators, if needed?
  • NUNM: qigong
  • SIAEM: tuina
• setting
  • AMU= warehouse
    • trails nearby (10-15 min drive), strip malls too
    • no school garden, but another school is next door, with a garden
    • easy parking
  • NUNM= old elementary school
    • river nearby (20 min walk), parks, school garden
    • terrible parking
  • SCUHS= huge campus, park-like
  • location/ convenience
  • distance from school?
  • Public transit?
  • Even if school environment is not perfect/ beautiful, there are usually parks nearby. Look at a map! Ask around! Take initiative.
• Dual degree/ not?
  • Allied modalities
• clinic: how well stocked is herbal pharmacy
• I love how AMU has so many fellow Asians, and both an English and Chinese track. Mostly western students and professors at NUNM and AFEA
• debt stats, from Acupuncture Today: http://www.acupuncturetoday.com/digital/index.php?i=721&Page=6
  • breakdown different kinds of loan repayment